Pediatricians and pediatric nurses often see young patients with
concussions, but a new survey suggests they may lack the tools and training to
diagnose and treat them.
Researchers found 127 out of 145 pediatric primary and emergency care
providers had referred at least one concussion patient to another doctor in the
last three months, even though many concussions can be handled in primary care
settings. And 16 percent of the providers said they didn't have the right
training to tell families about their child's diagnosis. "It was very
revealing in that we need to make sure providers are educated about all the
signs and symptoms of concussions," said lead author Dr. Mark Zonfrillo,
an emergency physician and injury researcher at the Children's Hospital of
Philadelphia Center for Injury Research and Prevention.
The findings come amid increasing awareness and concern about the
long-term consequences of concussions in kids, especially in young athletes
playing contact sports. Zonfrillo said the survey was done as a way for his
healthcare network to evaluate the needs of its doctors and nurses who treat
kids with concussions. "We weren't sure what to expect. I think the thing
that stood out is that the providers were very honest with us in describing
what their needs are," he said.
Zonfrillo and his colleagues, who published their results in the journal
Pediatrics, emailed surveys to 276 pediatric healthcare providers in the
Children's Hospital of Philadelphia Care Network and Emergency Department,
including doctors, nurses and physician assistants. The survey asked providers
about their knowledge of concussion symptoms and treatments and what may stand
in their way of helping patients. Just over half of the surveys were returned.
They showed 91 percent of respondents had treated at least one child with a
concussion in the last three months.
The majority of those providers referred their concussion patients to
another doctor. When the researchers asked why, 49 percent of primary care
providers - such as family doctors - said they were not comfortable treating a
concussion and 47 percent said they did not have the resources. Doctors and
nurses working in the emergency room had another reason for referring their
patients to other doctors. Specifically, 68 percent of those providers said it
is not appropriate to treat a concussion in an emergency setting.
Zonfrillo said it's understandable for ER workers to refer patients, but
his team's goal is for primary care providers to treat the majority of
concussions. "Reserving their referrals to a concussion specialist to
(patients) who have prolonged symptoms or pre-existing conditions would sort of
help in broader healthcare management and resource management," he added.
NOT UP TO
SNUFF'
The researchers also included two scenarios in their survey, which asked
the providers about which symptoms are or are not needed to diagnose a child
with a concussion. One scenario described a patient with an obvious concussion
and the other described subtler symptoms. Almost all of the providers correctly
diagnosed each patient with a concussion, but some missed certain symptoms.
About one in six did not think a patient's inability to follow a finger
with their eyes was relevant to a concussion diagnosis, along with one in 10
who did not think trouble concentrating was relevant. "What the study says
is that we need to get the frontline people up to snuff," said brain
injury researcher Paul Comper, from the University of Toronto, who added that
he didn't think there's anything "Earth shattering" in the new study.
The providers in the study seemed to agree that they needed help. All
doctors and nurses without specific discharge instructions for concussion
patients said that type of tool would be helpful, and 96 percent of those who
did not already have tools to help diagnose or treat concussions said that
would help them. Zonfrillo said his healthcare network used the information to
create a new set of tools for its providers to standardize diagnosis and
management of concussions. From July to mid-October, he said the tools were
used over 850 times.
Comper and the researchers warned, however, that this is only the
experience of one system in the U.S., and may not represent what's happening at
other hospitals and doctors' offices around the country. "As long as
people are using up-to-date evidence and implementing that in their care network,
that can make a big difference," said Zonfrillo.
Source: Chicago Tribune
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